Dental therapists — a midlevel provider similar to a physician assistant or nurse practitioner — will become a new profession in Arizona on Aug. 3.

Arizona is the seventh state in the U.S. to allow dental therapists as a licensed profession, said Kristen Mizzi Angelone, dental campaign manager for the Pew Charitable Trusts.

Under the law signed by Arizona Gov. Doug Ducey on Wednesday, dental therapists will only be allowed to practice in certain settings — tribal settings, federally qualified health centers and other non-profit community health centers treating low-income patients.

Dental therapists are seen by supporters as a way of addressing Arizona's oral health needs by doing a limited scope of dental procedures such as fillings, extractions and crowns at a lower cost.

The original bill was sponsored by Sen. Nancy Barto, a Republican from Phoenix who has long said adding dental therapists is a "free market solution" to meeting oral health needs in the state.

Members of the Tohono O'odham Nation southwest of Tucson were among the most vocal supporters of the legislation as they see it as offering a career path for tribal members to remain on the reservation. Tribal members have also indicated interest in setting up dental therapy coursework at Tohono O'odham Community College.

The laws says that for someone to become a dental therapist, they must first be licensed as a dental hygienist and graduate from a three-year dental therapy training program accredited by the Council on Dental Accreditation, and complete a clinical competency examination.

The Arizona Dental Association had been highly critical of creating a new dental profession but in the end agreed to the law that was passed.

The association worked with advocates from Dental Care for Arizona ensure dental therapists enter into a written collaborative agreement with an Arizona-licensed dentist. All billing would go through that dentist or the dentist's clinic.

The final version of the law also rolls back the type of extractions a dental therapist could do under general supervision. The law stipulates that dental therapists may not extract permanent teeth unless they are under the direct supervision of a dentist.

"Though we made significant improvements to the original version of the bill, we still do not believe dental therapy is the answer to Arizona’s oral health care challenges," said Dr. Robert Roda, a Scottsdale endodontist and president of the Arizona Dental Association. "We will continue to work with the Legislature to comprehensively address the real oral health problems facing our fellow Arizonans."

The dentists had argued that there are other ways to improve oral health in Arizona, such as adding more teledentistry, removing administrative barriers within the managed care system for Medicaid, and attracting more dentists to rural areas.

State. Rep. Pamela Powers Hannley, a Tucson Democrat, said the new law will create new, high quality jobs while increasing access to safe, quality and affordable oral healthcare to Arizonans who currently lack access.

Dental therapists are already practicing on tribal lands in Alaska, as well as in Minnesota and on tribal lands in Oregon and Washington state. Maine and Vermont have passed dental therapy legislation and are developing educational programs to train dental therapists. About 12 other states are currently considering laws that would allow dental therapists, Mizzi Angelone said.

While Arizona tribes may hire federally-certified dental therapists from out-of-state tribes once the new law takes effect in August, it's expected to be several years before Arizona schools start graduating dental therapists.

"I think Arizona is going to be a model for other states. Arizona was the first state to really start looking at dental therapy after the Commission On Dental Accreditation implemented new dental therapy standards," Mizzi Angelone said.

"What is included in the Arizona law is really modeled on a national standard."

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